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1.IntroductionHistochemical analysis is the classical method for studying atherosclerotic lesions and their pathophysiological progression. However, this method usually requires trained personnel for the sample preparation, which includes slicing artery wall tissue and staining for optical microscopy, rendering this procedure complex, time consuming, and limited to in-vitro conditions. Optical spectroscopy is a powerful characterization tool sensitive to the variation of molecular components in the sample, and has been applied for rapid classification of cell and tissue samples. 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13 Recent studies have shown that the vulnerability of atherosclerotic plaque largely depends on its chemical composition and ultrastructure. Different spectroscopic techniques, including fluorescence spectroscopy, Raman techniques, and near-infrared (NIR) spectroscopy, have been used to characterize normal tissues and plaques in human artery samples. Fluorescence spectroscopy has been used to study normal and atherosclerotic tissues based on endogenous or exogenous tissue chromophores, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27 successfully classifying normal and plaque artery tissues in vitro. In a more recent study, Marcu demonstrated a catheter-based time-resolved fluorescence spectroscopic technique for in-vivo differentiating and demarking macrophage content versus collagen content in a rabbit atherosclerotic model.28 Christov have shown a catheter-based fluorescence emission analysis technique applied to the detection of Russell’s viper venom-induced atherosclerotic plaque disruption in rabbit models during in-vitro and in-vivo studies.29 The same fluorescence technique was also utilized for in-vivo analyzing of quantitative changes in collagen and elastin during arterial remodeling in rabbit models.30 However, fluorescence techniques provide limited discriminatory information at a molecular level due to broad and frequently overlapping absorption and emission spectra obtained from tissue chromophores. Fourier-transform (FT) Raman with near-infrared (NIR) excitation has extensively been applied for qualitative and quantitative studies on the chemical composition of atherosclerotic plaques, and appears to be among the most promising techniques at present for the identification of vulnerable plaques. 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42 Recently, van de Poll applied Raman spectroscopy to studying the effects of diet and lipid-lowering therapy on plaque development in apoloprotein (APO) -Leiden transgenic mice.43 Furthermore, in-vivo Raman spectroscopy techniques have gained importance for intravascular detection. The group of Boschman 44 has utilized an in-vivo fiber optic probe for obtaining high-quality Raman spectra characterizing the artery wall in lambs and sheep. Further progress on in-vivo detection was achieved by Motz demonstrating a fiber optic probe-based Raman system applied to real-time in-vivo collection of Raman spectra in the human atherosclerosis system.45, 46, 47 In addition, a variety of IR spectroscopic techniques including diffuse reflectance NIR spectroscopy,48, 49, 50, 51 conventional transmission Fourier transform infrared (FT-IR) spectroscopy,52 attenuated total reflectance (ATR) spectroscopy,53 and FT-IR microscopy54 have been used for characterizing and identifying atherosclerotic plaques. A variety of spectroscopic mapping/imaging techniques, such as fluorescence,55 Raman,56, 57 reflectance NIR,58 transmission FT-IR microscopy,59 and ATR FT-IR techniques60 have also been used to characterize atherosclerotic plaques. Among these imaging techniques, micro-ATR FT-IR imaging,60 as recently demonstrated by Colley, provides the inherent advantage of superior sensitivity and significantly faster data acquisition compared to Raman imaging techniques, and simultaneously higher resolution than other FT-IR-based imaging techniques. In this study, the cross section of atherosclerotic rabbit arteries is analyzed at a spatial resolution of , thereby revealing the distribution heterogeneity of cholesterol esters in plaque. Consequently, among the optical techniques for studying atherosclerotic plaque, IR-ATR techniques are of particular interest due to their surface sensitivity and rapid data acquisition, which renders them ideal for thick and strongly absorbing materials such as tissue. In addition, ATR techniques are suitable for miniaturization, providing the potential to obtain spectroscopic signals and diagnostic information in vivo, if coupled with fiber optic signal delivery systems. In our study, reflectance IR microscopy and IR-ATR spectroscopy have been applied for the investigation of normal and atherosclerotic rabbit aorta samples, in preparation for the development of an IR-ATR-based catheter system61, 62, 63 for future in-vivo applications. All data presented in this study were obtained from intact aorta samples, and all spectra were generated from the inner surface of intima. Atherosclerotic and normal rabbit aorta samples show a significant difference in chemical composition governed by the water, lipid, and protein content. However, initial reflectance IR studies on hydrated rabbit aorta samples revealed that the difference between plaque and normal aorta tissue is very subtle due to averaging of the spectra within the measured area, as determined by the ATR element. Therefore, tissue classification by direct evaluation of the spectroscopic differences is virtually impossible for such IR-ATR catheter technology. Hence, instead of evaluating a few individual spectroscopic features for identification of rabbit aorta samples, multivariate data analysis strategies were adopted and applied to the spectral range of the data . Principle components analysis (PCA) was combined with Raman spectroscopy in a study by Deinum to identify three classes of human coronary artery.36 Discriminant analysis using Mahalanobis distance was applied to PCA scores extracted from Raman spectra of human artery tissue, enabling classification into three categories.37 Cacheux and Weinmann coupled partial least square (PLS) regression with Raman spectroscopy for quantifying the cholesterol and cholesterol ester concentration in human and rabbit aorta tissue,38, 39 suitable for identifying lipid-rich plaques prone to disruption. In the present study, we have successfully applied PLS discriminate analysis (PLS-DA) and linear discriminant analysis, along with Mahalanobis distance calculations, to data obtained by reflectance IR microscopy for the classification of lesion and nonlesion rabbit aorta tissue, demonstrating 100% predictive accuracy of the developed multivariate classification models during blind testing. Training data were collected from atherosclerotic and normal rabbit aorta samples. The spectra collected using the presently developed ATR FT-IR catheters63 in our research group inherently present an average across a certain tissue area, defined by the contact area of the ATR element with the lesion or the aorta wall surface. However, the results in this study demonstrate that IR-ATR spectroscopy combined with multivariate classification techniques has the potential to identify normal and atherosclerotic aorta, which provides a sound basis for the development of in-vivo IR-ATR diagnostic devices. 2.Materials, Methods, and Multivariate Data Analysis2.1.Tissue SamplesFive New Zealand White male rabbits were used to obtain the training sample set for building the classification models in this study: four were approximately old; one was approximately old. The six months old and one of the -old rabbits were fed a normal diet of rabbit chow. The remaining three rabbits were fed rabbit chow supplemented with 1% (w/w) cholesterol (Harlan Teklad, Indianapolis, Indiana) daily for eight weeks to induce atherosclerotic lesions.64 One additional normal-fed and one additional cholesterol-fed rabbit (approximately old) were used to obtain the first set of test samples (12 in total) for validation of the established classification models. Two more normal-diet and two more cholesterol-fed rabbits (approximately old) were used to obtain the second set of test samples (56 in total) to further validate the classification models. Their weight and blood cholesterol levels were monitored every other week. For harvesting the aorta tissue, the rabbit was anesthetized and given an overdose of sodium pentobarbital. After euthanasia, the aorta tissue was excised and stored in 0.9% sodium chloride (NaCl) solution. Normal and atherosclerotic aortas (or aorta areas) were identified by visual inspection. Aortas from the rabbits on a normal diet appeared inconspicuous without evident lesions. One cholesterol-diet rabbit revealed lesion streak scattering along the inner wall of the aorta; two cholesterol-diet rabbits were characterized by atherosclerotic aortas, where the aorta inner wall was entirely covered by lesions. Tissue samples were cut into segments with a diameter of using a biopsy device (Bio-punch, Health Link, Jacksonville, Florida) for spectroscopic measurement. 2.2.Reflectance Infrared MicroscopyReflectance spectra (single beam), which were collected with an FT-IR spectrometer (Thermo Nicolet, Nexus 470, Thermo Electron Corporation, Somerset, New Jersey) coupled to an IR microscope (Spectra-Tech IR Plan, Vermont Optechs Incorporated, Charlotte, Vermont) were used as training data to build multivariate models for classifying lesion and nonlesion aorta tissue. The biopsy sample (diam ) was placed on a glass slide, and the slide was positioned on the microscope stage. Spectra were collected at resolution from , averaging 32 interferometer scans per measurement from a spot. All lesion aorta samples were obtained from one of three cholesterol-diet rabbits; nonlesion aorta samples were prepared from the old normal-diet rabbit. A total of 14 biopsies from each kind of sample (lesion and nonlesion) were taken, and five IR reflectance spectra were recorded for each biopsy. The five measurements of each biopsy are denominated through in the remainder of this study. The first spectrum of each through set was measured three minutes after removal of the sample from the saline. The remaining spectra ( through ) were measured at intervals thereafter. By standardizing the data collection in this way, the effects of loss of water to evaporation were presumed to be reproducible from sample to sample for each spectrum through . Since the maximum penetration depth for MIR radiation into tissue is approximately (or less in the presence of water), it can also be presumed that the reflectance signals obtained were generated entirely or at least predominantly from the intima.6 Two sets of test samples were independently investigated following the same procedure described before. The obtained data were then classified utilizing the multivariate classification models developed in the first phase of this study. 2.3.Infrared Attenuated Total Reflectance SpectroscopyIR-ATR spectra were collected with a single reflection diamond ATR accessory (Golden Gate, Specac Limited, Orrington, United Kingdom) in the same FT-IR spectrometer. In total, 29 dehydrated biopsy samples with a diameter of were investigated, comprising ten lesion samples from the atherosclerotic aorta of the second cholesterol-diet rabbit, and ten nonlesion samples from the aorta of the old rabbit. The remaining nine samples were taken from nonlesion regions from the normal aorta regions of the third cholesterol-diet rabbit. Prior to the measurement, each biopsy sample was prepared by rinsing with deionized (DI) water, drying with lens paper, and then exposure to air for approximately . The dehydrated tissue samples were centered on the top of the circular diamond ATR element. To ensure sufficient contact between the tissue sample and the diamond, a constant pressure was applied via a built-in adjustable plunger. Spectra were collected at resolution from , averaging 16 spectra per measurement. 2.4.Multivariate Data AnalysisPLS̱Toolbox̱3.5 (Eigenvector Incorporated, Wenatchee, Washington) was used to generate the classification models. Principal components regression (PCR), partial least squares (PLS), partial least squares linear discriminant analysis (PLS-DA), and Mahalanobis distance were applied on the first and last spectra of each dataset obtained with IR reflectance microscopy, and on hydrated and dehydrated tissue data obtained with the IR-ATR method. The obtained spectra for each particular set of experiments were always mean centered prior to multivariate analysis. Cross-validation (leaving one sample out) was performed to determine the optimal number of principal components (PC) or latent variables (LV). 3.Results and Discussion3.1.Reflectance Infrared Microscopy3.1.1.Average spectra of classification dataAverage spectra of the first and last measurements of the training set aorta samples are shown in Fig. 1 . From these plots, it is clearly evident that the spectral differences between lesion and nonlesion tissue samples are very subtle. The experimental results obtained in this study convincingly demonstrate that sophisticated multivariate data analysis and classification techniques are essential to robust and reliable sample classification for diagnostic purposes. 3.1.2.Multivariate classification results using dataIn the following multivariate classification, lesion samples were assigned class 1, and nonlesion samples class 2. IR reflectance spectra were preprocessed by meancentering prior to further analysis.65 PLS-DA is a discrimination method developed from PLS regression models.66 Based on the root mean square error for cross validation (RMSECV) results for PLS-DA shown in Fig. 2a , four latent variables (LVs) are selected as optimal numbers to minimize error during classification and prediction. In general, four or six LVs were tested to build the statistical models. The corresponding classification and prediction results are shown in Figs. 2b and 2c. Ideally, lesion samples have a value of 0.5, and nonlesion samples have a value of . However, the predicted values frequently deviate from the ideal hit values due to the variations of the samples within the same class. In all plots shown next, points 1 to 14 represent lesion training samples (class 1); 15 to 28 nonlesion training samples (class 2); and 29 to 40 samples from the first test set. The establishment of the model using the training samples (1 to 28) by Wang preceded the measurement of the unknown samples (by Chapman) by six months owing to tissue availability schedules. For the 12 samples from the first test set, only the raw single beam IR spectra were provided for evaluation without any indication of the number of lesion versus nonlesion cases among the 12 samples. The identity of the test samples was shared only after the classification had been made. Threshold values were calculated using the observed distribution of the predicted values and the Bayesian theorem for discriminating the two different classes. As shown in Fig. 2c, blue bars are a histogram of the predicted values for class 1 samples; green bars are a histogram of the predicted values for class 2 samples. The threshold is the cross point of two normally fitted histograms. The Bayesian statistics also provide the probability that a sample is a member of a certain class given the predicted value. The prediction probability results for both four LV and six LV PLS-DA models based on all investigated samples are shown in Table 1 . Given a sample, its probability belonging to class 1 is calculated using Eq. 1. where is the predicted value from the PLS-DA model for the sample in question, is the probability of this sample being a member of class 1 given the value of , and is the probability of this sample being a member of class 2 given the value of . Consequently, a sample with a predicted value at the threshold has a 50% probability belonging to either class.Table 1Prediction probability results for PLS-DA models using a data. 1 to 28: training sample set; 1 to 14: lesion sample set; 15 to 28: nonlesion sample set; and 29 to 40: first set of test samples.
In the model using four LVs, sample 10 cannot be unambiguously classified, but its probability of belonging to class 1 is (see Table 1). Using this model, only test sample 30 was incorrectly classified. If six LVs were applied to establish the model, all samples could be correctly classified or predicted. Linear discrimination analysis (LDA) used before is a method to maximize the among-class difference relative to the within-class difference. The Mahalanobis distance67, 68 is a specific linear discriminant analysis method particularly suitable for classification, which was performed here by first compressing the spectral data to six latent variables and corresponding scores of a 6-D vector using PLS. Following this, the mean score vector and the mean-centered scores for each class (lesion or nonlesion) were calculated, and the covariance matrix of for each class was computed. For the prediction of a blind sample, its score would be calculated from the measured spectrum and latent variables, and mean centered by of one class. The distance of the mean-centered unknown score from of this class was computed and normalized by following Eq. 2. where , with indicating the number of training samples in one class.The distance of an unknown sample to the classes determines which class the unknown belongs to. The class that has less distance to the unknown will incorporate the unknown sample. From Fig. 3 it is evident that the Mahalanobis distance method has provided 100% successful classification and prediction of all samples in the first test set, similar to PLS-DA. 3.1.3.Multivariate classification results using dataBased on the RMSECV results (not shown), six LVs have been determined as the optimal number for the PLS-DA classification model. The corresponding classification results are shown in Fig. 4a . All training samples could be clearly classified with this method, and only test sample 40 could not be classified with sufficient certainty. Most probably, it would be incorrectly classified as a nonlesion sample. The corresponding histograms and the prediction probability results for the PLS-DA model using six LVs and data are shown in Fig. 4b and Table 2 . Table 2Prediction probability results for PLS-DA models using e data. 1 to 28: training sample set; 1 to 14: lesion sample set; 15 to 28: nonlesion sample set; and 29 to 40: first set of test samples.
The Mahalanobis distance method was also applied to classify data. The classification results are shown in Fig. 5 . Again, test sample 40 could not be correctly classified. Sample 30 could be classified more clearly using the Mahalanobis distance in contrast to using PLS-DA. Using the PLS-DA models developed before, classification of the second set of test samples was attempted, however, with reduced hit quality using both and data. Yet 74% of the samples were classified correctly using data, and 60% of the samples were classified correctly using data. The sensitivity and specificity of the PLS-DA model for the test samples were calculated using the method introduced by Balchum, 69 and are summarized in Table 3 . The lower classification rate is attributed to the limited diversity of the training sample set for developing the predictive models. Consequently, it is essential for introducing significantly more spectra for covering the variation among animals by using spectral imaging techniques, enabling the collection of large sets of model data in a reasonable period of time. The possible reason that using data provides (marginally) more accurate predictive results in contrast to using data may result from the fact that the sample had significantly changed during ambient exposure and the experimental procedure. It has to be considered that the dataset has been recorded as the fifth consecutive measurement starting after of an entire measurement series. Hence, due to water evaporation the sample was significantly drier compared to the beginning of the measurement series. In turn, this indicates that classification during hydrated conditions, which more closely resemble the in-situ environment, is more accurate. Alternatively, the application of principal components regression (PCR) techniques was investigated for the and data series of the first test set to discriminate between lesion and nonlesion classes. 1 was the preset value for all lesion samples, and 0 was for all nonlesion samples.70 All spectra were again mean centered prior to PCR. The predicted lesion value ideally centers at 0.5, and the nonlesion at . However, PCR-based classification failed in accurately classifying data. Figure 6 shows the PCR results using data. A total of nine PCs were selected for the model, and all training samples could be accurately classified. Test sample 40 was incorrectly classified as nonlesion, similar to PLS-DA and the Mahalanobis distance method. In addition, test sample 35 could not be clearly predicted with the horizontal zero line as the discriminator, as the prediction value was only slightly above zero. In contrast to PCR, the PLS-DA method not only considers the changes in the spectra, but instantaneously also considers the changes in concentration of the various constituents (or class difference in our case). Due to uncertainties introduced by the sample preparation process and ambient effects during the measurements, the among-group difference is not always larger than the within-group difference. Hence, PCR appeared to be the least able to provide satisfactory classification results. The sensitivity and specificity of the investigated multivariate methods for test samples of the first test set without any a priori knowledge are summarized and compared in Table 3. 3.2.Infrared Attenuated Total Reflectance SpectroscopyThe average spectra for lesion samples and for nonlesion samples using single reflection ATR spectroscopy are shown in Fig. 7 . Spectral differences are most evident in the region . However, spectra collected from individual dehydrated nonlesion samples also show relatively strong absorptions in the spectral region of and at approximately . These characteristics appear smoothed out in the average spectra, and the classification of these samples might render difficult if these spectral features are used as only identifiers. Therefore, chemometric analysis is essential for obtaining reliable tissue classification models. Table 3Sensitivity and specificity of the investigated multivariate data analysis methods for training and test samples.
PLS-DA was applied on IR-ATR data after preprocessing of the spectra by mean centering. Lesion samples were assigned class 1, and nonlesion samples class 2. Five LVs were selected for building of PLS-DA classification model. The corresponding classification results are shown in Fig. 8a . The prediction probability calculated using the Bayesian theorem is 1 for all tissue samples. Alternatively, the Mahalanobis distance was applied on dehydrated tissue data collected using IR-ATR. The classification results based on the five latent variables derived from the PLS-DA are shown in Fig. 8b. Alternatively to building a model using all samples in the dataset as training samples, the data were separated into a training set and a validation set. The validation set was used to test the robustness of model established with the training set. This operation was performed five times, each time with a different set of five or six samples selected as validation data (two lesion, and three or four nonlesion samples). The remaining 23 or 24 samples were used as training data. Eventually, each sample was selected into the validation dataset once, and tested once. Five LVs were applied for all five calibration models, similar to the model using all data. All five models turned out sufficiently robust and predicted the corresponding validation samples with 100% hit quality. Alternatively, PCR was tested also on the IR-ATR samples; however, it failed to accurately classify the samples, as previously discussed. 4.ConclusionPLS-DA (or PLS) and Mahalanobis distance linear discriminant analysis methods are applied to mid-infrared microspecular reflectance data and mid-infrared ATR data of lesion and nonlesion biopsy samples of rabbit aorta. Both methods achieve 100% hit quality with outstanding sensitivity and specificity during tests on small sets of samples. More diverse test sets reveal that larger training datasets, such as those provided by IR imaging techniques, are required for accurate classification, although up to 89% correct classification results are obtained. Consequently, the overall results reveal a promising prospect for successful classification of lesion versus nonlesion tissue samples. The fundamentals of the approach presented in this study are currently being expanded and tested with an IR-ATR catheter system for future in-vivo diagnostics during plaque ablation.63 AcknowledgmentsThe authors would like to thank Aya Eguchi (Duke University) for support during the data collection and discussion, and Ellen Dixon-Tulloch (Duke University) for rabbit care, euthanasia, and tissue harvesting. This study was in part supported by NIH grant R01 HL067111 and R01 EB000508. ReferencesK. Stehfest,
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